摘要
目的探讨静脉输注利多卡因对丙泊酚靶控输注时不同意识状态的预测效应部位浓度及熵指数的影响。方法择期全麻下骨科下肢手术患者60例,ASAⅠ或Ⅱ级,年龄18～60岁,随机均分为利多卡因1.0mg/kg组（L1组）、利多卡因1.5mg/kg组（L2组）和对照组（C组）。麻醉开始前L1组、L2组分别给予利多卡因1.0mg/kg和1.5mg/kg,C组给予等容量的生理盐水,1min后采用靶控输注丙泊酚行全麻诱导。观察入室安静后10min（T1）、靶控输注前（T2）、插管前即刻（T3）、插管后即刻（T4）、插管后3min（T5）、插管后5min（T6）时熵指数、MAP、HR、SpO2、OAA/S评分。记录靶控输注期间语言反应消失时（LVC）、意识消失时（LOC）即刻的熵指数和丙泊酚的预测效应部位浓度。结果与T1、T2时比较,C组T3、T5、T6时和L1、L2组T3～T6时MAP均明显降低（P〈0.01）;与T1、T2时比较,三组T3～T6时RE和SE均明显降低（P〈0.01）;与T3时比较,C组T4时MAP、HR、RE和SE明显升高（P〈0.01或P〈0.05）,而L1、L2组差异无统计学意义。三组患者在LVC、LOC时的熵指数和丙泊酚的预测效应部位浓度差异无统计学意义。结论静注利多卡因1.0mg/kg或1.5mg/kg,对不同意识状态时丙泊酚靶控输注的预测效应部位浓度和熵指数并无显著的影响,但可减轻气管插管时的应激反应,并抑制气管插管刺激时的熵指数升高。
Objective To observe the influence of intravenous lidocaine on the predicted effectsite concentration and entropy at different clinical end point during target-controlled infusion of propofol（TCI）.Methods Sixty patients,with ASA Ⅰ orⅡ,aged 18-60 years for both genders,scheduled to undergo elective operation by general anesthesiawere randomly allocated into three groups：intravenous 1.0mg/kg lidocaine group（group L1）,intravenous 1.5mg/kg lidocaine group（group L2）and control group（group C）.Group L1 was treated with lidocaine 1.0mg/kg,group L2 was treated with lidocaine 1.5mg/kg and group C was given equal volume of normal saline one minute after induction of anesthesia with TCI of propofol.The entropy,MAP,HR,SpO2,OAA/S score were recorded at baseline（T1）,before TCI（T2）,pre-intubation（T3）,immediately after intubation（T4）,3min after intubation（T5）and 5min after intubation（T6）.The immediate entropy and predicted effect-site concentration of propofol were recorded at the loss of verbal contact（LVC）and loss of consciousness（LOC）.Results When compared with T1 and T2,there was a significant decrease in MAP at T3,T5,T6 in group C（P〈0.01）and at T3-T6 in group L1 and group L2（P〈0.01）.Response entropy（RE）and state entropy（SE）had a significant decrease at T3-T6 than those at T1,T2 in all the three groups（P〈0.01）.Compared with T3,MAP,HR,RE and SE were significantly higher at T4 in group C（P〈0.01 or P〈0.05）,while there were no significant difference in group L1 and group L2.The entropy and predicted effect-site concentration of propofol showed no significant difference at LVC or LOC in the three groups.Conclusion Intravenous 1.0mg/kg or 1.5mg/kg lidocaine cannot affect the predicted effect-site concentration and entropy at different clinical end point during TCI of propofol but it can decrease the stress response and suppress the increment of entropy following endotracheal intubation.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2015年第6期534-537,共4页
Journal of Clinical Anesthesiology
